ISSN:1356-1294    

DOI:10.1111/j.1365-2753.1995.tb00012.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:1356-1294    

DOI:10.1111/j.1365-2753.1995.tb00013.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractThe US outcomes movement assumes, and sometimes argues, the primacy for medical practice of probabilistic knowledge derived from methodologically rigorous statistical studies. ‘Evidence‐based medicine,’ then, is considered a course of clinical medicine prescribed by such research. Implementation of evidence‐based medicine has recently been uneven in the US, manifesting not only the expected ‘obstacles to implementation’ but several theoretical weaknesses of the applied science model of medical care.Outcomes researchers claim to provide certainty ‐ certainty of what probable, as it turns out ‐ in a world of clinical uncertainty. This paper argues that outcomes research actually exacerbates the inferential uncertainty of practising physicians who would use knowledge for practice. Two quandaries are discussed: whether to privilege rigorous or relevant research, and whether to privilege universal or local knowledge. In each case, the logic of ‘evidence‐based medicine’ is insuffcient to resolve the quandary and would seem to support conflicting resolutions. Recent developments in US health policy are cited as manifestations of these quandaries. Finally, the reader is asked not to disregard the political implications of

ISSN:1356-1294    

DOI:10.1111/j.1365-2753.1995.tb00014.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractThere is increasing pressure to measure and publicize the quality of health care, with, for example, hospital ‘league tables’; appearing regularly in the lay press. Equally, there is increasing recognition that such simplistic presentations of data can be seriously misleading, as differences in case mix mean that they do not compare like with like.We discuss what is required of a statistical model if it is to be used to make comparisons of clinical performance which are adjusted for case mix. Outcome measures must be well defined and relevant, and the risk factors used in the model must reflect the patient's potential prognosis rather than aspects of his or her clinical care. In addition, the calibration of the statistical model is crucial.We review a number of established clinical scoring systems and demonstrate that they fail to meet all of the required criteria. Of particular concern is the fact that these scoring systems are susceptible to biases which could actually mask differences in performance. We highlight areas where further research is required, with the aim of stimulating progress in this fi

ISSN:1356-1294    

DOI:10.1111/j.1365-2753.1995.tb00015.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractTo detect bad research in published articles, it is necessary to know what to look for. Some examples of the types of poor study design, inappropriate analyses and pitfalls of interpretation which can occur are presented.

ISSN:1356-1294    

DOI:10.1111/j.1365-2753.1995.tb00016.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractIf the relative effectiveness of different treatments that might be used in clinical practice is to be evaluated reliably, it is very important that the evaluation is carried out in an appropriate manner. This is especially true where the differences between treatments are expected to be moderate, and so easily obscured by the play of chance or systematic bias. Although such differences are often of considerable clinical importance, they can be difficult to assess and require a large amount of randomized evidence. This evidence can be obtained through prospective randomized controlled trials, meta‐analysis of results from past randomized trials, or ideally a combination of the two, with prospective trials contributing to future meta‐analyses. Whichever technique is adopted, all possible biases must be minimized through the collection of as much randomized evidence as possible. In meta‐analyses, this is best achieved by ensuring that all relevant trials, and all randomized participants in these trials, are included in the analysis. The gold standard for this might be a meta‐analysis of individual patient data, in which details for each participant in every trial are collected and analysed centrally. This approach requires considerable time and effort. However, it will add to the analyses that can be performed and will remove many of the problems associated with a reliance on published data alone and some of the problems that can arise from the use of aggregate data. This paper sets out some of the reasons for this and some of the techniques used for individual patient data‐based meta

ISSN:1356-1294    

DOI:10.1111/j.1365-2753.1995.tb00017.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:1356-1294    

DOI:10.1111/j.1365-2753.1995.tb00018.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:1356-1294    

DOI:10.1111/j.1365-2753.1995.tb00019.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:1356-1294    

DOI:10.1111/j.1365-2753.1995.tb00020.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:1356-1294    

DOI:10.1111/j.1365-2753.1995.tb00021.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY